Individual
MR. JERRY DALE WILMATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW LPC
Contact information
Practice address
2024 N 14, POPLAR BLUFF, MO 63901
(573) 718-9315
(573) 686-2647
Mailing address
2024 N 14, POPLAR BLUFF, MO 63901
(573) 718-9315
(573) 686-2647
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC000167
MO
1041C0700X
Clinical Social Worker
Primary
003564
MO
Other
Enumeration date
08/02/2006
Last updated
09/11/2025
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